BMC Neurology最新文献

Background: Spontaneous intracerebral hemorrhage (SICH) is a severe stroke with high mortality and disability rates. Endoscopic surgery is an increasingly widely used minimally invasive method for the treatment of SICH. However, the impact of fever on patient outcomes remains unclear.

Methods: We retrospectively included patients aged 18 years or older with supratentorial SICH confirmed by CT, who underwent endoscopic hematoma evacuation within 48 h of symptom onset. The primary outcome was the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included hospital and neurosurgical intensive care unit (NSICU) stays, and perioperative complications. We analyzed the association between postoperative fever (highest temperature within 24 h after surgery) and these outcomes using multivariate analysis, generalized additive models, and segmented regression analysis.

Results: Of the 56 patients, 38 had favorable outcomes (mRS ≤ 3) and 18 had unfavorable outcomes (mRS > 3) at 3 months. A threshold effect at 38.2 °C was observed between postoperative body temperature and clinical outcomes. The mean age was 56 years (SD = 9) for the > 38.2 °C group and 58 years (SD = 8) for the ≤ 38.2 °C group, with a similar proportion of male patients (63% vs. 69%, P = 0.635). Patients with postoperative fever had larger hematoma volumes (65 vs. 56 mL; P = 0.008). Other characteristics were similar between the groups. Postoperative fever (> 38.2 °C) was independently associated with a 4.99-fold increased risk of unfavorable outcomes (95% CI = [1.13 to 25.90]; P = 0.040), which remained significant after excluding patients with postoperative complications (adjusted RR = 16.03, 95% CI = [1.69 to 417.24]; P = 0.033). The association was consistent across subgroups with different Glasgow Coma Scale scores, hematoma volumes, and intraventricular extension. Postoperative fever was also associated with longer NSICU stays (3.1 vs. 2.3 days; P = 0.023), longer hospital stays (17.2 vs. 13.6 days; P = 0.010), more residual hematoma, and greater edema volume. Different antipyretic therapies did not affect outcomes.

Conclusions: This study identifies a temperature threshold (38.2 °C) associated with poor outcomes in SICH patients undergoing endoscopic surgery. Further research is needed to mitigate postoperative fever and improve patient outcomes.

Background: The absence of guidelines for the nursing management of individuals living with epilepsy, who are students in Ghana, has resulted in the high dropout rates of such students. It is our hope, that in the near future, these individuals living with epilepsy will receive the needed attention, experience less stigmatization and discrimination. This, we expect, will result in better retention of such students in schools, improved academic performance and successful graduation. To achieve this, there is the need to develop appropriate guidelines and implement same for their benefit. In line with this, the study aims to develop guidelines for nurses to manage individuals living with epilepsy in Ghanaian schools.

Methodology: Qualitative approach will be adopted to conduct this study in two phases. In the first phase, a case study design will be deployed in the Twifo Atti-Morkwa District of the Central Region of Ghana. The case is the nursing management of individuals living with epilepsy within the school context, and the sources of information will be the general nurses, psychiatric, or community psychiatric nurses working at the schools. Within the context of the case, parents or guardians of individuals living with epilepsy in the schools as well as their teachers will be included in the study. Data will be collected through individual interviews for nurses and parents while focus group discussions will be used for the teachers. Thematic analysis will be used to analyze the data. In the second phase, guidelines will be developed using the modified e-Delphi Technique. The study will be piloted in the Komenda-Edina-Eguafo-Abrem Municipality of the Central Region of Ghana. Ethics approval for this study has been obtained from the Ethical Review Committee of the University of Pretoria in South Africa. Additionally, Administrative approvals have been obtained from the Ghana Education Service.

Discussion: The guidelines developed will form the basis for nursing management of individuals living with epilepsy in Ghanaian schools. This will help to improve educational outcomes for the individuals living with epilepsy.

Background: Excessive daytime sleepiness (EDS) is a common complication of stroke that has a detrimental effect on patients' daily life and functional recovery. The clinical characteristics and risk factors for poststroke EDS may differ between males and females.

Methods: A retrospective study based on hospital medical records was conducted on patients with a diagnosis of stroke who participated in polysomnographic monitoring at the Affiliated Hospital of Yangzhou University from February 2022 to May 2024. Baseline data, laboratory test data, polysomnographic data, and related scale scores were retrospectively collected. The Epworth Sleepiness Scale (ESS) score was used to assess EDS after stroke. Binary logistic regression was used to determine the risk factors for daytime sleepiness. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Statistical analysis was performed via IBM SPSS 26.0.

Results: ESS scores were higher in males than in females, whereas females had higher Pittsburgh Sleep Quality Index (PSQI) scores and Hospital Anxiety and Depression Scale (HADS) scores. Male sex and higher depression scores were risk factors for EDS; among male patients, higher anxiety scores were a risk factor for EDS, whereas smoking was a protective factor. Depression, a higher arousal index and a reduced proportion of N3 sleep periods were risk factors for EDS in females.

Conclusions: The characteristics and influencing factors of EDS differ between the sexes in patients with mild and moderate ischaemic stroke. Our study may provide evidence and guidance for clinical diagnosis and treatment. Interventional studies are needed to assess the impact of treating these risk factors in the future.

Background: Atrial fibrillation (AF) is a significant risk factor for stroke, imposing a substantial burden on healthcare systems. While studies have shown varying AF prevalence among stroke patients, limited pooled data exists in low-resource settings like Ethiopia. This hinders our understanding of the problem's extent and limits effective prevention and management strategies. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of atrial fibrillation among stroke patients in Ethiopia.

Methods: The searches were carried out in electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar. Observational study designs were selected, and studies published until 30 November 2023 addressing the prevalence of atrial fibrillation among stroke patients were identified. Endnote citation manager software version X₉ for Windows was used to collect and organize the search outcomes and remove duplicate articles. The relevant data were extracted from the included studies using a format prepared in Microsoft Excel and exported to STATA 18.0 software for the outcome measures analyses and subgrouping.

Results: Twenty-three research articles were included in the final analysis. These studies evaluated a total of 4,544 stroke patients, of whom 529 were diagnosed with atrial fibrillation (AF). The overall pooled prevalence of AF among stroke patients was 13% [95% CI: (10%, 17%)]. Subgroup analysis by region revealed that the highest pooled prevalence of AF was 16% [95% CI: (8%, 25%)] in the Amhara region, followed by the Oromia region at 15% [95% CI: (7%, 23%)]. In Addis Ababa City, the pooled prevalence of AF among stroke patients was 11% [95% CI: (7%, 15%)]. The Tigray region reported a pooled prevalence of 9% [95% CI: (6%, 11%)]. However, one study from the Southern Nations, Nationalities, and Peoples' Region reported a lower prevalence of AF among stroke patients at 7% [95% CI: (3%, 11%)].

Conclusion: In summary, the study revealed that AF is prevalent among stroke patients in Ethiopia, with regional differences in prevalence. The high prevalence of AF emphasizes the necessity for effective management strategies to prevent recurrent strokes.

Systematic review registration number: PROSPERO CRD: CRD42024581661.

Introduction: Balance impairment is one of the common impairments in patients after stroke. It can lead to depression reduced speed of mobility, dependent on assistive device and reduce quality of life. However, evidence on balance impairment and its risk factors among stroke survivors in Ethiopia was lacking particularly in the study area. Therefore, this study aimed to investigate prevalence and associated factors of balance impairment among stroke survivor's attendee at an outpatient clinic in Amara regional state comprehensive specialized hospital.

Methods: An institutional based cross-sectional study was conducted from April1-June 30, 2022. A total of 400 participants were selected using the systematic random sampling technique. Standard Berg balance scale tool and semi-structure questionnaire was used. Multicollinearity and model fitness were checked. Variables with a p-value of less than 0.25 in the Bivariable regression were entered into a multivariable logistic regression and p value < 0.05 was used as cutoff point for significant variables.

Result: The prevalence of balance impairment was 51.5% (95% CI (46.58, 56.39). Being depressed (AOR = 12.25:95% CI (4.727, 31.779), using walking aids (AOR = 8.76:95%CI3.469, 22.117)), abnormal speed (AOR = 6.73:95%CI (2.671, 16.977)), did not have physiotherapy treatment (AOR = 3.96:95%CI (1.483, 10.586), and unmarried (AOR = 2.71, 95% CI = 1.061, 6.903) were significantly associated with balance impairment.

Conclusion and recommendation: The prevalence of balance impairment in the study was high. Being depressed, use walking aids, did not have physiotherapy treatment, abnormal speed of mobility, and unmarried were significantly associated factors. Therefore; it is better to give greater emphasis for those factors.

Background: Marchiafava-Bignami disease (MBD) is an exceptionally rare condition, a fact that should pique the professional curiosity of medical practitioners. In recent years, case reports of this disease have been infrequent, and no comprehensive analysis or summary of the characteristics of the published cases has been conducted.

Methods: We collected the medical records of three patients treated at our hospital from March 2022 to March 2023. Furthermore, we searched PubMed for "case reports" from January 2017 to March 2023 and included 30 cases. By retrospectively analyzing these 33 cases, we summarized the characteristics of the disease.

Results: Based on our analysis, we found that MBD primarily affects middle-aged men and typically has an acute or subacute onset, with the primary clinical manifestations being disturbances of consciousness, speech disorders, cognitive impairment, and psychiatric or behavioral abnormalities, often leading to misdiagnosis of psychiatric disorders. Most patients have a history of alcohol consumption or malnutrition. Head CT or MRI revealed symmetric lesions in the corpus callosum, with the splenium being the most commonly affected area. Lesions might also involve white matter outside the corpus callosum, and a wider range of lesions suggested a poor prognosis. However, the prognosis is generally favorable with timely and adequate administration of B vitamins, providing reassurance to medical professionals and patients alike.

Conclusion: The early recognition and treatment of Marchiafava-Bignami disease are paramount, as they can significantly improve the prognosis. This underscores the critical need for prompt clinical intervention in the early stages of the disease, instilling a sense of urgency and significance in the work of medical professionals.

Background: Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening subtype of stroke. Prompt and appropriate anticoagulation is crucial for improving the prognosis of CVST and preventing its recurrence. Identifying the underlying cause of CVST is decisive for guiding anticoagulant selection and determining treatment duration.

Case presentation: A 50-year-old man presented with a 35-day history of headache, nausea, vomiting, and blurred vision. Digital subtraction angiography performed at another facility revealed CVST. A contrast-enhanced black-blood MRI at our center confirmed the diagnosis, which was supported by a high intracranial pressure of 330mmH₂O. Laboratory tests showed elevated leukocytes and platelet counts, raising suspicion of an underlying myeloproliferative neoplasms (MPNs). A bone marrow biopsy demonstrated increased megakaryocytes and granulocytes, and genetic testing identified the presence of the Janus kinase 2 V617F (JAK2 V617F) mutation, leading to a diagnosis of pre-primary myelofibrosis (pre-PMF). During hospitalization, anticoagulation with nadroparin calcium and fibrinolytic therapy were initiated. Upon discharge, rivaroxaban and aspirin were prescribed to prevent CVST recurrence and arterial thrombosis.

Conclusion: This case highlights the importance of recognizing dynamic changes in routine blood tests that may link CVST to underlying hematological disorders. The JAK2 mutation is not only associated with MPNs but also increases the risk of thrombosis, including CVST. Further investigation is warranted to better understand the mechanisms by which JAK2 mutations contribute to thrombosis and to explore the potential benefits of JAK2 inhibitors in reducing this risk.

Background: Real-world data were employed to determine clinical characteristics of patients with myasthenia gravis (MG) with differing degrees of muscle weakness, as defined using the Myasthenia Gravis Foundation of America (MGFA) classification system.

Methods: Data were drawn from the Adelphi MG Disease Specific Programme (DSP)™, a multinational (United States, France, Germany, Italy, Spain, United Kingdom) survey completed by physicians and their patients with MG in 2020. The association between MGFA class and impairment in activities of daily living (ADL) was tested using linear regression adjusting for sex and Charlson Comorbidity Index. Bivariate comparisons were performed for each individual item. A range of other clinical characteristics were also explored according to MGFA class.

Results: Among 1232 patients, those in MGFA class I had significantly lower ADL impairment versus class II or III/IV (adjusted for sex and Charlson Comorbidity Index) (p < 0.01). However, heterogeneity occurred within each MGFA class. Bulbar symptoms (impaired speech, difficulty swallowing, and/or difficulty chewing/choking on food) were reported in some class I patients (mild in 1.1-1.9% and moderate in 0.3-1.1% of patients) and class II patients (mild in 8.5-16.4%, moderate in 4.7-7.4%, and severe in 0.3-0.9% of patients), and shortness of breath was reported in some class I (mild in 0.5% of patients) and class II patients (mild in 9.8%, moderate in 4.8%, and severe in 0.3% of patients). Conversely, in 11.2-19.2% of class III/IV patients, bulbar symptoms and shortness of breath reported were only mild in severity. In line with this finding, despite significant correlations between MGFA class and several clinical characteristics, patients across every class were at risk of experiencing myasthenic crisis or hospitalization, experiencing comorbidities including anxiety and depression, and not being in remission.

Conclusions: Although MGFA class correlates with greater ADL impairment and presence of other clinical characteristics, there is variability between patients in each class in terms of symptoms experienced, overall disease burden, and the precise nature of ADL impairment.

Background: Progressive multifocal leukoencephalopathy (PML) is an often fatal disease of the central nervous system caused by opportunistic infection of John Cunningham Polyomavirus (JCV). There's still no antiviral therapeutic strategy which was generally recognized as effective. The prognosis may differ in patients with different pathological mechanisms and treatments. We aim to report the effectiveness of combined treatment of low-dose, long-term immunoglobulin and mirtazapine in a pathologically proved PML case.

Case presentation: A patient presented with progressive acalculia, right-left confusion and visual neglection was recorded. She received 10-year immunosuppressive therapy for dermatomyositis. White matter lesions located in bilateral parietal lobe and callosum area symmetrically in MR scanning. JC virus analysis and brain biopsy in left parietal lobe were performed. The number of JCV copies was 2595 in CSF and 282,809 in brain specimen. Abundant foamy macrophages and the lymphatic cells were obvious in immunohistochemistry staining. Few SV-40 positive JC infected cell and more CD4 + and CD68 + cells were predominant. Immunosuppressive drugs were terminated after being diagnosed as PML for positive JCV and pathological characteristics. In addition, immunoglobulin (5 g/day) and mirtazapine (45 mg/day) were used. JC virus in CSF decreased to 0 after treatment for 4 months and was still negative in June 2023. The clinical symptoms improved, and white matter lesions recovered significantly.

Conclusions: We demonstrated that the combination treatment of IVIG and mirtazapine was effective in PML. Low-dose, long-term immunoglobulin might regulate the immune status in our case with controlled inflammatory reaction instead of destructive virus spreading. The therapy may be a prospective option for PML.

Background: Multiple sclerosis (MS) is a leading cause of neurological disability among young and middle-aged adults worldwide, and disability is measured using a variety of approaches, including patient reported outcome measures (PROMs) such as the Patient Determined Disease Steps (PDDS) scale. There is limited evidence for the validity of inferences from the middle-range of scores on the PDDS (i.e., 3 "gait disability" - 6 "bilateral support"), but that range of scores seemingly represents moderate disability characterized by varying levels of walking dysfunction.

Purpose: The current study examined whether the middle-range of scores from the PDDS reflect varying levels of walking dysfunction among people with MS.

Method: Participants (N = 374) completed the Patient Determined Disease Steps (PDDS) scale, Multiple Sclerosis Walking Scale-12 (MSWS-12), timed 25-foot walk (T25FW), six-minute walk (6 MW), Modified Fatigue Impact Scale (MFIS), and Multiple Sclerosis Impact Scale-29 (MSIS-29), and underwent a neurological exam for generating an Expanded Disability Status Scale (EDSS) score as part of screening and baseline data collection for a clinical trial of exercise training in MS. We undertook a series of linear trend analyses that examined differences in the outcomes of EDSS, T25FW, 6 MW, MSWS-12, MFIS subscales, and MSIS-29 subscales across the 4 levels of PDDS scores (i.e., 3-6).

Results: There were statistically significant and strong linear trends for EDSS (F_1,370 = 306.1, p < .0001, η² = 0.48), T25FW (F_1,370 = 161.0, p < .0001, η² = 0.32), 6 MW (F_1,370 = 178.9, p < .0001, η² = 0.34), and MSWS-12 (F_1,370 = 97.0, p < .0001, η² = 0.24). There was a strong correlation between PDDS and EDSS scores (r_s = 0.695, 95% CI = 0.643, 0.748). Both PDDS and EDSS scores had strong correlations with walking outcomes, yet weaker correlations with measures of fatigue and QOL.

Conclusion: The PDDS could serve as a simple, inexpensive, and rapidly administered PROM for remote screening and early detection of walking dysfunction for initial eligibility into clinical trials and practice for managing mobility-specific disability in MS.

Registration: The study was registered on ClinicalTrials.gov on March 19, 2018 (NCT03468868).